Trauma is defined as an injury caused by a physical force; examples include the consequences of motor vehicle accidents, falls, drowning, gunshots, fires and burns, and stabbing or other physical assault.

Trauma kills more people between the ages of 1 and 44 than any other disease or illness. According to the National Center for Health Statistics, trauma (including unintentional injuries and homicides) causes:

43 percent of all deaths from ages 1-4

48 percent of all deaths from ages 5-14

62 percent of all deaths from ages 15-24

According to the American Trauma Society, 100,000 Americans of all ages die from trauma each year.

Surgical procedures are considered a form of controlled injury, so many of the medical complications faced by surgery patients are very similar to those faced by trauma victims.

Shock

Shock is defined as "circulatory collapse," when the arterial blood pressure is too low to maintain an adequate supply of blood to the body's tissues. Shock is characterized by cold and sweaty skin, weak and rapid pulse, irregular breathing, dry mouth, dilated pupils, and reduced flow of urine.

Shock can be caused by internal or external bleeding (hypovolemic shock), dehydration, burns, or severe vomiting and/or diarrhea--all of which involve the loss of large amounts of bodily fluids.

Other causes of shock include: the presence of microorganisms in the bloodstream (called bacteremic or septic shock), a severe allergic reaction (called anaphylactic shock), drug overdose (such as with narcotics or barbiturates), alterations in the ability of the heart to pump blood effectively (cardiogenic shock), and extreme emotional upset due to personal tragedy or disaster (neurogenic shock).

Burn

Burn is defined as tissue damage caused by a variety of agents, such as heat, chemicals, electricity, sunlight, or nuclear radiation. Most common are burns caused by scalds, building fires, and flammable liquids and gases.

First-degree burns affect only the outer layer (called the epidermis) of the skin.

Second-degree burns damage the epidermis and the layer beneath it (called the dermis).

Third-degree burns involve damage or complete destruction of the skin to its full depth and damage to underlying tissues. People who experience such burns often require skin grafting.

The swelling and blistering characteristic of burns are caused by the loss of fluid from damaged blood vessels.

In severe cases, such fluid loss can cause shock, requiring immediate transfusion of the patient with blood or a physiological salt solution to restore adequate fluid levels to maintain blood pressure.

Burns often lead to infection, due to damage to the skin's protective barrier. In many cases, topical antibiotics (creams or ointments applied to the skin) can prevent or treat such infection. The three topical antibiotics that are most widely used are silver sulfadiazene cream, mafenide acetate cream, and silver nitrate.

According to the American Burn Association, each year in the United States, 1.25 million burn injuries require medical attention.

Approximately 50,000 of these require hospitalization, and roughly half of those burn patients are admitted to a specialized burn unit.

Each year, approximately 4,500 of these people die.

Up to 10,000 people in the United States die every year of burn-related infections; pneumonia is the most common infectious complication among hospitalized burn patients.

Twenty years ago, burns covering half the body were routinely fatal; today, patients with burns covering 90 percent of the body can survive (but often with permanent impairments).

Practices that have contributed to this improvement include advances in resuscitation, wound cleaning and follow-up care, nutritional support, and infection control.

Grafting with natural or artificial materials can also speed the healing process.

Complications

Complications following injury, shock, or burns may occur long after the initial incident, often when the patient is in an intensive care unit (ICU). Many ICU patients face similar medical problems regardless of the reason for their admission into the unit.

The leading causes of death in ICUs are multiple organ system dysfunction, in which several of the body's organs fail at once, and adult respiratory distress syndrome, in which the lungs in particular fail. In both conditions, the organs of the body are ravaged by the patient's own immune system, leading to severe, debilitating, and uncontrolled inflammation.

Improving methods of wound healing and tissue repair offers tremendous opportunities to enhance the quality of life for trauma and burn patients, and may also help to reduce health care costs.

Scientists are investigating ways to treat wounds caused by trauma, burns, or surgical interventions with biological agents (e.g. growth factors) or new drugs.

The National Institute of General Medical Sciences (NIGMS), one of the National Institutes of Health (NIH), sponsors research--mostly basic but some clinical--in the areas of burn, shock, and trauma. Other NIH components support or conduct research in aspects of trauma, burn, and injury related to their missions, as well.

To obtain more information about trauma and burn research funded by NIGMS, contact the Office of Communications and Public Liaison: